Abstract

Clinical reasoning is a skill required by all health professionals in managing patients. Research in clinical reasoning has come mostly from medicine and nursing, less from dentistry. The effect of curriculum on the development of clinical reasoning is still not well understood. Moreover, no research has been conducted to understand what clinical reasoning means to students and what educational strategies are valued by them. The aim of this research is to explore the effect of different educational strategies in different dental schools on clinical reasoning and to discover how students perceive clinical reasoning.

Final year students from four different dental schools participated in the current research; a school using an integrated curriculum with conventional teaching, a school using Problem Based Learning (both from the UK) and two Saudi Arabian dental schools; a school using a traditional curriculum and a school using an integrated curriculum. Both UK schools participated in both studies, whereas each one of the Saudi Arabian schools participated in a different study. The research used both quantitative and qualitative methodology. An innovative clinical reasoning test measured final year students’ skills. An interview captured their own understanding of clinical reasoning and its acquisition plus they ‘talked through’ a clinical problem, using a ‘think aloud’ technique. Thematic analysis was used to analyse the transcripts of the recorded interviews. Results obtained were related to curriculum structure.

The results indicated that the effect of curriculum structure, unlike teaching and assessment strategies, appeared to be minimal in final year students. Unfamiliarity with the term clinical reasoning was common in students. Students from different schools used different strategies to reason when discussing clinical vignettes. Different behaviours seemed to be affected by cultural factors.

This research contributes to a greater understanding of how students learn, understand and apply dental clinical reasoning which hopefully will improve educational practices in the future.